Healthcare Provider Details

I. General information

NPI: 1275369787
Provider Name (Legal Business Name): ORTHOSC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 PROFESSIONAL PARK DRIVE
CONWAY SC
29526
US

IV. Provider business mailing address

210 VILLAGE CENTER BLVD STE 140
MYRTLE BEACH SC
29579-6706
US

V. Phone/Fax

Practice location:
  • Phone: 843-353-3460
  • Fax: 843-353-3461
Mailing address:
  • Phone: 843-353-3460
  • Fax: 843-353-3461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JENIFER EDELEN
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 843-213-6149